Psychopharmacology, 2nd ed: A mental health professional's guide to commonly used medications

Unlocking the enigma of effective medication management in mental health. This comprehensive guide offers mental health professionals a practical roadmap to the use of psychotropic drugs in clinical settings. It's a resource born out of Herbert Mwebe's extensive experience in mental health care and academia, and it delves deep into the intricacies of treating mental illnesses such as psychoses, depression, dementia, and bipolar disorder. The book covers four key areas: the history and effects of psychotropic drugs, the importance of individualised care, the critical role of combining medication with alternative interventions, and the necessity of monitoring and managing adverse effects. The book provides a detailed overview of the recommended medications for adults with mental health disorders. It stresses the importance of a personalised, multidisciplinary approach to patient care. It emphasises the critical role of combining medication with psychosocial interventions for treating mental illnesses. Lastly, it underscores the necessity of monitoring and managing the adverse effects associated with these medications. This book empowers mental health professionals to make informed decisions about prescribing psychotropic drugs, leading to improved patient outcomes. They will be better equipped to manage the adverse effects of medications, integrate pharmacological and psychosocial treatment strategies, and provide personalised care, irrespective of their level of proficiency. The book also serves as a valuable tool in meeting Nursing and Midwifery Council (NMC) competencies in medication management. Cover 1 Title page 3 Copyright information 4 Table of contents 5 Meet the author 9 Acknowledgements 10 Foreword 11 Praise for the first edition 13 Introduction 17 The structure of this book 18 Learning features 18 1 Mental illness 20 1.1 Introduction 20 1.2 Aetiology of mental illness 22 1.3 Neurodevelopmental theories 24 Neurons and neurotransmitters 24 1.4 Clinical decision making in practice, and medicine management and optimisation 29 Psychosocial interventions in mental health settings 36 2 Drugs used in psychoses 44 2.1 Introduction 44 Severe mental illness 44 Schizophrenia 45 2.2 Mechanism of action 47 Biochemical theories 47 Glutamate hypothesis 47 Dopamine hypothesis 48 Typical antipsychotics 51 Atypical antipsychotics 53 2.3 Dose and administration 59 Rapid tranquillisation 59 Non-restrictive interventions 67 Antipsychotic drugs in depot preparation 70 Cytochrome P450 drug-metabolising enzymes interaction with psychotropics 75 2.4 Adverse effects and management 80 Extrapyramidal side effects 80 Dystonia 81 Management of dystonia 82 Akathisia 82 Management of akathisia 83 Drug-induced parkinsonism 83 Management of drug-induced parkinsonism 84 Tardive dyskinesia 85 Management of tardive dyskinesia 85 Anticholinergic drugs 87 Non-extrapyramidal adverse effects of antipsychotic drugs 88 Muscarinic 1 receptor block 88 Cardiovascular effects 89 Weight gain and mental illness 93 Gender 94 Socioeconomic status and level of education 94 Age 95 Other contributing factors to weight gain in people with mental illness 95 Metabolic syndrome 96 Glycaemic abnormalities as a consequence of treatment and mental illness 96 Endocrine adverse effects 97 Allergic and dermatological effects 98 Haematological adverse effects 99 Obligatory monitoring for clozapine therapy 100 Clozapine alert 101 Other adverse effects of clozapine 102 Neuroleptic malignant syndrome 102 Improving physical health needs in SMI: best practice monitoring 104 Behavioural change initiatives alongside routine physical health monitoring 106 Lester Cardiometabolic Tool 106 National Early Warning Score 2 (NEWS 2) 107 QRISK®3 107 2.5 Medication adherence in mental health settings 108 3 Drugs used in depression 113 3.1 Introduction 113 ICD-11: key changes in relation to depression diagnostic criteria 115 Screening for depression and anxiety in primary care settings 116 Co-morbid psychiatric presentations 117 Key points about assessment and management of symptoms of depression and anxiety in primary care 119 3.2 Mechanism of action 123 Monoamine theory of depression 123 3.3 Dose and administration 126 3.4 Adverse effects and management 132 Tricyclic antidepressants 132 Adverse effects and management 133 Selective serotonin reuptake inhibitors 134 Adverse effects and management 136 Serotonin–noradrenaline reuptake inhibitors 137 Adverse effects and management 137 Tetracyclic (noradrenergic and specific serotonergic antidepressants) 138 Adverse effects and management 139 Aminoketone (bupropion) 139 Adverse effects and management 140 Monoamine oxidase inhibitors 140 Precautions, side effects and management 141 Reversible inhibitor of monoamine oxidase type A (RIMA) 142 Side effects 142 Serotonin syndrome 142 3.5 Differences in therapeutic effects of antidepressants 143 4 Drugs used in dementia 148 4.1 Introduction 148 Dementia assessment and diagnosis: best practice 149 4.2 Mechanism of action 150 Acetylcholinesterase inhibitors 150 4.3 Dose and administration 152 4.4 Adverse effects and management 153 Acetylcholinesterase inhibitors 153 Cholinergic crisis 154 Polypharmacy in the older person 155 Antipsychotic therapy in the care of the older person 156 4.5 Memantine (NMDA receptor antagonist) 156 Mechanism of action 156 Concomitant use of cholinesterase inhibitors and memantine 157 Adverse effects and management of memantine 157 5 Drugs used in bipolar disorder 163 5.1 Introduction 163 The aetiology of bipolar disorder 164 Bipolar disorder clinical presentation and management 165 5.2 Mechanism of action 167 5.3 Dose and administration 168 Lithium 169 Valproate 171 Dose and administration of valproate 171 Carbamazepine 172 Dose and administration of carbamazepine 172 Lamotrigine 173 Dose and administration of lamotrigine 174 5.4 Adverse effects, monitoring and management 174 Lithium 174 Adverse effects 175 Lithium toxicity 176 Valproate 178 Carbamazepine 180 Lamotrigine 182 6 Drugs used in anxiety disorders 187 6.1 Introduction 187 Types of anxiety 188 Generalised anxiety disorder 188 Panic disorder 188 Social anxiety disorder 188 Agoraphobia 188 Separation anxiety 188 Specific phobias 188 Medication-induced anxiety disorder 189 6.2 Mechanism of action 190 Benzodiazepine hypnotics and anxiolytics 190 Non-benzodiazepine hypnotics 191 Melatonin 192 Non-benzodiazepine anxiolytics 192 6.3 Dose and administration 194 6.4 Adverse effects and management 196 Adverse effects of benzodiazepines 196 Paradoxical reaction 197 Withdrawal from benzodiazepines 197 Managing withdrawal symptoms 198 Risk of overdose with benzodiazepines 198 Treatment in overdose 198 Adverse effects of non-benzodiazepine hypnotics (Z-drugs) 199 Promethazine 200 Precautions and interactions (benzodiazepines and hypnotics) 200 Adverse effects of non-benzodiazepine anxiolytics 203 Buspirone 203 Pregabalin 203 Beta blockers (propranolol) 204 7 Drugs used in alcohol and substance misuse 208 7.1 Introduction 208 7.2 Most vulnerable groups to substance use disorders 211 7.3 The mesolimbic dopamine circuit as the key reward pathway component 212 How does cocaine and methamphetamine use affect the functioning of the reward circuit? 214 7.4 Drug tolerance, dependence, addiction 215 Tolerance 215 Some facts about tolerance 216 Dependence 216 Addiction 217 7.5 The psychopharmacology of commonly used drug substances and their effects 218 Club (party) drugs 218 7.6 Care planning and management of substance misuse disorders 235 7.7 Medications used to treat alcohol dependence, smoking cessation and other drug dependencies 239 Drug-related deaths 251 Severe mental illness and smoking cessation 253 Appendix: Answers to chapter review questions and MCQs 264 Chapter 1 264 Chapter 2 267 Chapter 3 272 Chapter 4 275 Chapter 5 279 Chapter 6 282 Chapter 7 286 ANSWERS TO MULTIPLE CHOICE QUESTIONS 289 Study activity 1: Multiple choice questions 289 Study activity 2: Multiple choice questions 289 Study activity 3: Multiple choice questions 290 Study activity 4: Multiple choice questions 290 Study activity 5: Multiple choice questions 290 Study activity 6: Multiple choice questions 291 Study activity 7: Multiple choice questions 291 Study activity 8: Multiple choice questions 291 Study activity 9: Multiple choice questions 291 Study activity 10: Multiple choice questions 292 Study activity 11: Multiple choice questions 292 Glossary 293 References 303 Index 325 An Updated And Revised Edition Of This Accessible Best-selling Text Suitable For All Trainee And Registered Health Professionals Who Require Knowledge And Understanding Of Drugs Used In The Treatment Of Mental Health Conditions For Prescribing Or Administering Purposes.